title: Neighbourhood income and neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality in Canada, 1991-2005.
abstract: BACKGROUND
  Rates of infant mortality declined in Canada in the 1990s and 2000s, but the extent to which all socio-economic levels benefitted from this progress is unknown.
  
  
  OBJECTIVE
  This study investigated differences and time trends in neonatal, postneonatal and sudden infant death syndrome (SIDS) mortality across neighbourhood income quintiles among live births in Canada from 1991 through 2005.
  
  
  METHODS
  The Canadian linked live birth and infant death file was used, excluding births from Ontario, Yukon, Northwest Territories and Nunavut. Mortality rates for neonatal, postneonatal and sudden infant death syndrome (SIDS) were calculated by neighbourhood income quintile and period (1991-1995, 1996-2000, 2001-2005). Hazard ratios (HR) for neighbourhood income quintile and period were computed, adjusting for province of residence, maternal age, parity, infant sex and multiple birth.
  
  
  RESULTS
  In urban areas, for the entire study period (1991-2005), the poorest neighbourhood income quintile had a higher hazard of neonatal death (adjusted HR 1.24, 95% CI 1.15-1.34), postneonatal death (adjusted HR 1.58, 95% CI 1.41-1.76) and SIDS (adjusted HR 1.83, 95% CI 1.49-2.26) compared to the richest quintile. Postneonatal and SIDS mortality rates declined by 37% and 57%, respectively, between 1991-1995 and 2001-2005 whereas no significant change was observed in neonatal mortality. The decrease in postneonatal and SIDS mortality rates occurred across all income quintiles.
  
  
  CONCLUSIONS
  This study shows that despite a decrease in infant mortality and SIDS across all neighbourhood income quintiles over time in Canada, socio-economic inequalities persist. This finding highlights the need for effective infant health promotion strategies in vulnerable populations.
authors.affiliation: Maternal and Infant Health Section, Public Health Agency of Canada, Ottawa, ON, Canada. nicolas.gilbert1@mail.mcgill.ca
authors.forename: Nicolas L
authors.initials: NL
authors.lastname: Gilbert
authors.forename: Nathalie
authors.initials: N
authors.lastname: Auger
authors.forename: Russell
authors.initials: R
authors.lastname: Wilkins
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
mesh_terms: D002170:Canada / Q000453:epidemiology; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000706:statistics & numerical data*; D007223:Infant; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D011204:Poverty Areas; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012307:Risk Factors; D013398:Sudden Infant Death / Q000453:epidemiology*
keywords: Infant mortality; social class; sudden infant death